Vicarious Living: Ecuador 2012: A Turning Point

On March 19 I had a meeting with the Regional Director of Latin America at University Research Corporation. The director was a former colleague of one of my project advisers, who is also a respected mentor. Following an email introduction, I had expressed my interest to the director about learning more about a maternal and child health project they were leading in the province of Cotopaxi, which is south of Quito. The meeting was absolutely great! I learned a lot about the role of URC in implementing evidence-based practices in many areas of public health. I did not previously understand the link between research and practice, so it was wonderful to meet with URC and develop a vision of the type of work I want to do in public health. I learned a lot about the maternal and child health project they are leading, too.

This four-year project works with traditional birthing attendants (parteros) in small villages. The goals are to improve the healthcare of the parteros without changing cultural traditions (such as vertical birth), and also improve the services in formal hospitals. The overarching theme is also to create networks of healthcare providers and community leaders that work together to reduce neonatal mortality. It's important that the parteros still deliver babies how they have delivered babies for years, but the project teaches them practices that improve the sanitation of delivery or the feeding of newborns, for example. There are many levels of people involved in the project, from towns to townships, counties, and finally the entire province. At each of these levels, project facilitators lead workshops for parteros, teaching and reinforcing the main points of neonatal health.

I'm really interested in this type of project that implements evidence-based practices to improve community health, specifically in the area of maternal and child health. I asked the nurse who leads the project (who was at the meeting on March 19) if I could accompany her to one of the workshops. She said "of course, I'm leaving tomorrow for a county-level workshop the following day." I was quite taken aback and not expecting this idea of mine to materialize so quickly! The workshop would be in Latacunga, a city south of Quito. I was not prepared to stay another night in Quito and accompany the nurse the next day, so I left the meeting with her phone number and the possibility of finding my way to Latacunga on my own. I returned to Pedro extremely excited and hopeful that I could go! (Who was I kidding, I have no real schedule and was at a standstill with the diabetes project...of course I could go!)

The next morning in Pedro I quickly contributed to my online class discussion, packed, and reserved a room at a hostel in Latacunga. I was off on my adventure. After the three hour bus to Quito (which ends at the north bus terminal), I had to get to the south bus terminal, where buses leave for Latacunga. It took me over an hour and a half (but only 50 cents!) to get through the long city, using public buses (well, actually three different public buses). Once in Quitumbe, the south bus terminal, I quickly boarded a bus to Latacunga and was proud of myself for navigating the busy city. There was a march of indigenous people in the highway just outside of Quito, so our bus driver turned off the bus as we waited half an hour for the march to pass. Unexpected but interesting. Finally in Latacunga after two hours, I found my $5-a-night-but-still-clean-and-accommodating-hostel then wandered a bit through the streets to find a bite to eat. The next morning I wandered around again then called the nurse, informing her that I would meet her in 10 minutes at her hotel! She was shocked yet thrilled.

Pretty building on my morning walk

One of the lovely plazas

I joined the nurse and two other members of the project team and we were driven (by a local driver who works for the project) out to an old country monastery where the workshop would be held. Many parteros had arrived the night before and were staying at the old monastery. It was a beautiful setting for the workshop. After breakfast and introductions, the parteros broke into groups for the training sessions. I observed a group led by a nurse from Latacunga and woman who works with the Intercultural Health division within the Ministry of Health, a native to the area who speaks Quechua, the indigenous language.

View from outside the old monastery.

It was so exciting to see so many parteros, there were over 50 of them from all over the county, all wearing the traditional garb. During the small-group training session, the main points that were taught/reinforced were hand washing; preparing the maletin (the bag that parteros bring with them to a birthing mother's home); delivery practices (such as cutting the umbilical cord and immediately putting the baby with the mother); and warning signs for pregnancy, postpartum mothers, and neonates. The parteros observed demonstrations, practiced different procedures, did role plays, drew pictures of warning signals, and participated in question/answer with the facilitators--there were many methods of reinforcing the same principles. Everyone was engaged and eager to learn. It was a long day at the workshop, but we were all fed breakfast, 2 snacks, lunch, and dinner. The workshop continued the next day until the mid-afternoon snack. Then the parteros rushed off to catch various buses back to their villages. I also rushed off, knowing that I must get back to the north bus terminal in Quito by 6pm when the last bus to Pedro leaves.

Attending the workshop was an incredible experience--I was able to observe methods for implementing community projects that, through previous courses or experiences, I had learned were effective, sustainable, and contextually-sensitive. Projects like this maternal and child health project are what I want my career to be. Getting excited and learning about URC and what they do has helped me realize that what I'm doing in Pedro with the diabetes project is a stepping stone to reaching my career goals. Just the motivation I've been needing!